Comparison of the Safety and Efficacy of Remimazolam for Sedation in Adults Undergoing Fiberoptic Bronchoscopy: A Meta-Analysis of Randomized Controlled Trials.
Soowon Lee, Hyo-Seok Na, Bon-Wook Koo et al.
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In 30 seconds
This systematic review and meta-analysis of randomized controlled trials compared remimazolam with other sedatives in adults undergoing fiberoptic bronchoscopy. Across 16 trials involving 2325 patients, remimazolam was associated with lower risks of respiratory depression, hypotension, and bradycardia than control sedatives; for respiratory depression, the relative risk was 0.51 (95% CI: 0.36-0.73, P<0.001). Procedure success rates were comparable. Sedation onset was faster than with dexmedetomidine but slower than with propofol, while emergence and PACU stay were shorter than with dexmedetomidine and midazolam.
Key findings
- Respiratory depression was reduced with remimazolam versus controls (RR: 0.51, 95% CI: 0.36-0.73, P<0.001).
- Remimazolam was associated with lower risks of hypotension (RR: 0.50, 95% CI: 0.34-0.73, P<0.001) and bradycardia (RR: 0.37, 95% CI: 0.22-0.65, P=0.001).
- Procedure success rates were comparable across groups (RR: 1.12, 95% CI: 0.98-1.28, P=0.097).
- Compared with dexmedetomidine and midazolam, remimazolam shortened emergence and PACU stay.
Why it matters
Sedation for bronchoscopy must balance patient comfort with respiratory and hemodynamic stability and timely recovery. This pooled randomized-trial evidence suggests remimazolam may offer advantages in these safety outcomes while maintaining comparable procedure success. Differences in onset and recovery relative to specific sedatives may also inform evaluation of sedation options, although the findings do not establish superiority for every outcome or comparator.